We work with people from all around the world and wellbeing is the focus of our support services. Everyone has a different experience of HIV but a common theme has been that HIV support and prevention services are a territory that are not always known and come with their own set of risks. ‘We should talk about the elephant in the room,’ I’d said, in one of our support groups discussing being safe in Queer spaces. Once I’d explained what the saying meant and focused on the topic, our service users seemed more daunted to discuss HIV than if an elephant had been in the room. Some of our service users actually curled up on their chairs or hugged the person next to them. ‘I’d rather deal with a real elephant!’ one said.

A fundamental lack of understanding and fear of contacting the NHS could have massive implications on someone’s health and wellbeing. Our service users have many fears about accessing a service: determining if it is an LGBTQI+ friendly space as well as a safe space for people seeking asylum. Add to that the concern that they may see someone from their home community in the building, or, if attending somewhere local, be seen accessing the building. Already, before they have even walked through the door, there are many anxieties and complications.

We know that GP services are available to people seeking asylum, but this is not always the message reception staff in GP surgeries and walk-in centres communicate to vulnerable individuals. This leaves those same vulnerable people even more confused and with a reinforced fear that they should not be accessing a service. We know that those who have suffered trauma can shy away from advocating for themselves and sometimes feel they don’t want to be a ‘burden’ to the country where they are claiming asylum. This is dangerous breeding ground for denial or for not getting the help someone needs.

What about people seeking asylum already living with HIV? They have many of the fears the others have plus the weight it bears on their support mechanisms. How can they possibly have open and honest conversations about their status when their minds are already filled with concerns like: if my partner finds out, he will dump me…or, if my friend finds out, they will not let me sleep on their sofa… or, if the rest of the house finds or opens a letter, I will be targeted…

One of our team supported someone who did not want to take any anti-viral medicine as their partner would find out about their status and they relied on the partner to translate for them. This obviously put the individual and the partner at great risk. We had several challenging conversations and helped them get some support from PositivelyUK and Doctors of the World.

I offered one-to-one sessions with a young man who contracted the virus from someone he met on an app. He was very angry and felt numb and unable to communicate his feelings and continued to engage in risky behaviours. I did some work on anger management and voicing his trauma and we signposted him to a local mental health charity but he said he felt guilty that he had ‘betrayed his freedom’; he was claiming asylum and now he had HIV. When I told him that he could live a relatively normal life with medicine in the UK, he was confused and perplexed; he was still holding onto misconceptions of the virus from back home and the practices to cure it there, which had triggered him.

So how do we help people seeking asylum navigate the services available? Have conversations, talk about the difficult things, recognise the common themes and that which is difficult as well as the relevant solutions needed. Normalise their fears. After all, these are many of the fears and concerns young people coming out have.

Some of our service users organised a day trip to access a sexual health clinic where they could get advice about PEP and PrEP that was far away from their community on the other side of London. In our support group meeting that week we practised what they might ask about. In the evening I received a phone call to say it had gone well and they felt empowered to access somewhere like this and take the reins.

A support service like ours offers a range of support – if you meet a person seeking asylum who is LGBTQI+, the single most important thing you can do is to advise they engage with a specific support service such as ours. LGBTQI+ people seeking asylum don’t always have peers who can support and challenge them when needed. I am in regular contact with places like Dean Street and Mortimer Market (leading sexual health services and HIV support for the LGBTQI+ community) and they are aware that a little extra time and support can go a long way with people seeing asylum. We’ve even had referrals from these services for people in need of a lawyer.

I remember at the end of that support group meeting where I addressed the elephant in the room, after I had spoken a service user turned around and said: ‘You mean…we must invite the elephant in and have a cup of tea? Let it all be ok?’ They had summed it up perfectly: keep talking, keep supporting, keep empowering.